Provider Demographics
NPI:1427204510
Name:KIRAN B DUA MD
Entity Type:Organization
Organization Name:KIRAN B DUA MD
Other - Org Name:NORTHRIDGE INDUSTRIAL FAMILY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-886-7322
Mailing Address - Street 1:8349 RESEDA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:818-886-7322
Mailing Address - Fax:818-886-8786
Practice Address - Street 1:8349 RESEDA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4622
Practice Address - Country:US
Practice Address - Phone:818-886-7322
Practice Address - Fax:818-886-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35425261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50288Medicare UPIN